Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI: A Meta-analysis
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Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI : A Meta-analysis. / Thestrup, Jakob; Hybschmann, Jane; Madsen, Thurid W; Bork, Nanna E; Sørensen, Jette L; Afshari, Arash; Borgwardt, Lise; Berntsen, Marianne; Born, Alfred Peter; Aunsholt, Lise; Larsen, Vibeke A; Gjærde, Line K.
In: Hospital pediatrics, Vol. 13, No. 10, 2023, p. e301-e313.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI
T2 - A Meta-analysis
AU - Thestrup, Jakob
AU - Hybschmann, Jane
AU - Madsen, Thurid W
AU - Bork, Nanna E
AU - Sørensen, Jette L
AU - Afshari, Arash
AU - Borgwardt, Lise
AU - Berntsen, Marianne
AU - Born, Alfred Peter
AU - Aunsholt, Lise
AU - Larsen, Vibeke A
AU - Gjærde, Line K
PY - 2023
Y1 - 2023
N2 - CONTEXT: Nonpharmacological strategies are increasingly used in pediatric procedures, but in pediatric MRI, sedation and general anesthesia are still commonly required.OBJECTIVES: To evaluate the effectiveness of nonpharmacological interventions in reducing use of sedation and general anesthesia in pediatric patients undergoing MRI, and to investigate effects on scan time, image quality, and anxiety.DATA SOURCES: We searched Ovid Medline, CINAHL, Embase, and CENTRAL from inception through October 10, 2022.STUDY SELECTION: We included randomized controlled trials and quasi-experimental designs comparing the effect of a nonpharmacological intervention with standard care on use of sedation or general anesthesia, scan time, image quality, or child and parental anxiety among infants (<2 years), children, and adolescents (2-18 years) undergoing MRI.DATA EXTRACTION: Standardized instruments were used to extract data and assess study quality.RESULTS: Forty-six studies were eligible for the systematic review. Limited to studies on children and adolescents, the meta-analysis included 20 studies with 33 873 patients. Intervention versus comparator analysis showed that nonpharmacological interventions were associated with reduced need for sedation and general anesthesia in the randomized control trials (risk ratio, 0.68; 95% confidence interval, 0.48-0.95; l2 = 35%) and nonrandomized studies (risk ratio, 0.58; 95% confidence interval, 0.51-0.66; l2 = 91%). The effect was largest among children aged 3 to 10 years when compared with older children and adolescents aged 11 to 18 years.LIMITATIONS: There was substantial heterogeneity among nonrandomized studies.CONCLUSIONS: Nonpharmacological interventions must be considered as standard procedure in infants, children, and adolescents undergoing MRI.
AB - CONTEXT: Nonpharmacological strategies are increasingly used in pediatric procedures, but in pediatric MRI, sedation and general anesthesia are still commonly required.OBJECTIVES: To evaluate the effectiveness of nonpharmacological interventions in reducing use of sedation and general anesthesia in pediatric patients undergoing MRI, and to investigate effects on scan time, image quality, and anxiety.DATA SOURCES: We searched Ovid Medline, CINAHL, Embase, and CENTRAL from inception through October 10, 2022.STUDY SELECTION: We included randomized controlled trials and quasi-experimental designs comparing the effect of a nonpharmacological intervention with standard care on use of sedation or general anesthesia, scan time, image quality, or child and parental anxiety among infants (<2 years), children, and adolescents (2-18 years) undergoing MRI.DATA EXTRACTION: Standardized instruments were used to extract data and assess study quality.RESULTS: Forty-six studies were eligible for the systematic review. Limited to studies on children and adolescents, the meta-analysis included 20 studies with 33 873 patients. Intervention versus comparator analysis showed that nonpharmacological interventions were associated with reduced need for sedation and general anesthesia in the randomized control trials (risk ratio, 0.68; 95% confidence interval, 0.48-0.95; l2 = 35%) and nonrandomized studies (risk ratio, 0.58; 95% confidence interval, 0.51-0.66; l2 = 91%). The effect was largest among children aged 3 to 10 years when compared with older children and adolescents aged 11 to 18 years.LIMITATIONS: There was substantial heterogeneity among nonrandomized studies.CONCLUSIONS: Nonpharmacological interventions must be considered as standard procedure in infants, children, and adolescents undergoing MRI.
U2 - 10.1542/hpeds.2023-007289
DO - 10.1542/hpeds.2023-007289
M3 - Journal article
C2 - 37727937
VL - 13
SP - e301-e313
JO - Hospital pediatrics
JF - Hospital pediatrics
SN - 2154-1671
IS - 10
ER -
ID: 370697787